The Covid‐19 pandemic highlighted the need to examine public trust in the U.S. Food and Drug Administration (FDA) vaccine approval process and the role of political influence in the FDA's decisions. Ensuring that the FDA is itself trustworthy is important for justifying public trust in its actions, like vaccine approvals, thereby promoting public health. We propose five conditions of trustworthiness that the FDA should meet when it reviews vaccines, even during emergencies: consistency with rules, proper expert or political decision‐makers, proper (...) decision‐making and noninterference, connection to public preference, and transparency of both reasons and procedures. The five conditions provide a road map of procedural and substantive requirements, which the FDA has variably implemented, focused on ensuring appropriate influence of political interests. While being a trustworthy agency cannot guarantee the public's trust, implementing these conditions builds a groundwork for public trust. (shrink)

1 Evidence-based policy requires researchers to provide the answers to ecological questions that are of interest to policy makers. To find out what those questions are in the UK, representatives from 28 organizations involved in policy, together with scientists from 10 academic institutions, were asked to generate a list of questions from their organizations. 2 During a 2-day workshop the initial list of 1003 questions generated from consulting at least 654 policy makers and academics was used as a basis for (...) generating a short list of 100 questions of significant policy relevance. Short-listing was decided on the basis of the preferences of the representatives from the policy-led organizations. 3 The areas covered included most major issues of environmental concern in the UK, including agriculture, marine fisheries, climate change, ecosystem function and land management. 4 The most striking outcome was the preference for general questions rather than narrow ones. The reason is that policy is driven by broad issues rather than specific ones. In contrast, scientists are frequently best equipped to answer specific questions. This means that it may be necessary to extract the underpinning specific question before researchers can proceed. 5 Synthesis and applications. Greater communication between policy makers and scientists is required in order to ensure that applied ecologists are dealing with issues in a way that can feed into policy. It is particularly important that applied ecologists emphasize the generic value of their work wherever possible. (shrink)

It is commonly held that p is a reason for A to ϕ only if p explains why A ought to ϕ. I argue that this view must be rejected because there are reasons for A to ϕ that would be redundant in any ex...

Background End-stage renal disease (ESRD) is the final stage of chronic kidney disease. Yet dialysis is not suitable for all ESRD patients. Moreover, while shared decision-making (SDM) is the preferred model for making medical decisions, little is known about SDM between nephrology nurses and ESRD patients in Israel. Research Objective Assessing the views, attitudes, practices, and ethical dilemmas of nephrology nurses in Israel regarding SDM with ESRD patients. Methods Using the descriptive quantitative approach, questionnaires were completed by 444 nephrology nurses (...) in Israel. In addition to conducting descriptive statistics, t-tests for independent samples, f-tests for analysis of variance, and both tests for independence were also performed. Ethical Considerations The research aims, expected advantages and risks have been explained to respondents before completing the questionnaire to secure informed consent. Anonymity and confidentiality were ensured throughout the study. The study was approved by the Research Ethics Committee at the University of Haifa (Approval # 411/21). Results About one-third (30%–36.5%) of nurses reported discussing quality of life issues with ESRD patients, asking about their advance directives/power of attorney, exploring cultural/religious beliefs in end-of-life care, and ask about their preferred place of death. Nurses who convey high levels of patient-centered care (68.9%, p<0.0001), have high end-of-life training (76.2%, p<0.0001), and report cooperating with interdisciplinary teams (63.8%, p = 0.0415), also reported higher SDM practices than others. Nurses who refer less patients to palliative care (70%, p<0.0001) reported higher involvement in SDM compared to other nurses. Conclusions Nephrology nurses in Israel do not tend to implement the SDM model, despite its potential for improving quality of life for ESRD patients and their families and increasing conservative care options. Policy makers and educators in Israel should develop and implement training programs and support in the workplace, to enhance SDM between nephrology nurses and ESRD patients. (shrink)

We thank Nielsen Busch and Mjaaland for their article on the dead donor rule (Nielsen Busch and Mjaaland 2023). We would like to take this opportunity to go beyond the dead donor rule in order to r...

For decades, physicians, philosophers, theologians, lawyers, and the public considered brain death a settled issue. However, a series of recent cases in which individuals were declared brain dead yet physiologically maintained for prolonged periods of time has challenged the status quo. This signals a need for deeper reflection and reexamination of the underlying philosophical, scientific, and clinical issues at stake in defining death. In this paper, I consider four levels of philosophical inquiry regarding death: the ontological basis, actual states of (...) affairs, epistemological standards, and clinical criteria for brain death. I outline several candidates for the states of affairs that may constitute death, arguing that we should strive for a single, unified ontological definition of death as a loss of integrated functioning as a unified organism, while acknowledging that two states of affairs may satisfy this concept. I argue that the clinical criteria for determining whole-brain death should be bolstered to meet the epistemic demand of sufficient certainty in defining death by adding indicators of cerebro-somatic dis-integration to the traditional triad of loss of consciousness, loss of brainstem function, and absence of confounding explanations. (shrink)

The surviving sources on the Stoic theory of division reveal that the Stoics, particularly Chrysippus, believed that bodies, places and times were such that all of their parts themselves had proper parts. That is, bodies, places and times were composed of gunk. This realisation helps solve some long-standing puzzles about the Stoic theory of mixture and the Stoic attitude to the present.

We often think about the alternatives to a decision that has been made. Thinking in this way is known as counterfactual thinking, that is, thinking about what could have been had an alternative dec...

Rights of nature is an idea that has come of age. In recent years, a diverse range of countries and jurisdictions have adopted these norms, which involve granting legal rights to nature or natural objects, such as rivers, forests, or ecosystems. This book critically examines the idea of natural objects as right-holders, and analyses legal cases, policies, and philosophical issues relating to this development. -/- Drawing on contributions from a range of experts in the field, Rights of Nature: A Re-examination (...) investigates the potential for this innovative idea to revolutionize the concepts of rights, standing, and recognition as traditionally understood in many legal systems. Taking as its starting point Stone’s influential 1972 article ‘Should Trees Have Standing?’, the book examines the progress rights of nature have made since that time, by identifying central themes, unifying principles, and key distinctions in how rights of nature discourse has been operationalized in the disciplines of law, philosophy, and the social sciences. These themes and principles are illustrated through a wide variety of examples, including ecosystem services, indigenous thinking, and ecological restoration, demonstrating how the relationship between humanity and the natural world may be transforming. -/- Taking a philosophical, political, and legal perspective, this book will be of great interest to students and scholars of environmental law and policy, environmental ethics, and philosophy. (shrink)

Increasingly, physicians are being asked to provide technical services that many believe are morally wrong or inconsistent with their beliefs about the meaning and purposes of medicine. This controversy has sparked persistent debate over whether practitioners should be permitted to decline participation in a variety of legal practices, most notably physician-assisted suicide and abortion. These debates have become heavily politicized, and some of the key words and phrases are being used without a clear understanding of their meaning. In this essay, (...) I endeavor, firstly, to clarify the meaning of some of these terms: conscience, conscientious action, professional judgment, conscientious objection, conscience clauses, civil disobedience, and tolerance. I argue that use of the term conscientious objection to describe these refusals by health care professionals is mistaken and confusing. Secondly, relying on a proper understanding of the moral and technical character of medical judgment, the optimal deference that the state and markets ought to have toward professions, and general principles of Lockean tolerance for a diversity of practices and persons in a flourishing, pluralistic, democratic society, I offer a defense of tolerance with respect to the deeply held convictions of physicians and other health care professionals who hold minority views on contested but legal medical practices. (shrink)

Pellegrino has argued that end-of-life decisions should be based upon the physician's assessment of the effectiveness of the treatment and the patient's assessment of its benefits and burdens. This would seem to imply that conditions for medical futility could be met either if there were a judgment of ineffectiveness, or if the patient were in a state in which he or she were incapable of a subjective judgment of the benefits and burdens of the treatment. I argue that a theory (...) of futility according to Pellegrino would deny that latter but would permit some cases of the former. I call this the circumspect view. I show that Pellegrino would adopt the circumspect view because he would see the medical futility debate in the context of a system of medical ethics based firmly upon a philosophy of medicine. The circumspect view is challenged by those who would deny that one can distinguish objective from subjective medical judgments. I defend the circumspect view on the basis of a previously neglected aspect of the philosophy of medicine -- an examination of varieties of medical judgment. I then offer some practical applications of this theory in clinical practice. (shrink)

Horan offers a substantial challenge to the narrative of radical orthodoxy's idiosyncratic take on Scotus and his role in ushering in the philosophical age of the modern. This volume not only corrects the received account of Scotus but opens a constructive way forward toward a positive assessment and appropriation of Scotus's work for contemporary theology. --Book cover.

Health care has increasingly come to be understood as a commodity. The ethical implications of such an understanding are significant. The author argues that health care is not a commodity because health care (1) is non-proprietary, (2) serves the needs of persons who, as patients, are uniquely vulnerable, (3) essentially involves a special human relationship which ought not be bought or sold, (4) helps to define what is meant by necessity and cannot be considered a commodity when subjected to rigorous (...) conceptual analysis. The Oslerian conception that medicine is a calling and not a business ought to be reaffirmed by both the profession and the public. Such a conception would have significant ramifications for patient care and health care policy. (shrink)

One of the most important questions in the debate over the morality of euthanasia and assisted suicide is whether an important distinction between killing patients and allowing them to die exists. The U.S. Supreme Court, in rejecting challenges to the constitutionality of laws prohibiting physician-assisted suicide, explicitly invoked this distinction, but did not explicate or defend it. The Second Circuit of the U.S. Court of Appeals had previously asserted, also without argument, that no meaningful distinction exists between killing and allowing (...) to die. That court had reasoned that if this were so, it would be discriminatory to allow persons on life support to end their lives by removing such treatment, while those who are not connected to life support would be denied similar access to death. (shrink)

Dear Norm,Thank you for sharing such a personal and heartfelt essay. I have been asked by the editors to comment. Reading it inspires me to do so in a similarly heartfelt way. Although I don't know you well, I thought I'd write to you as if you were my patient.I share your sense that Alzheimer disease is a terrible scourge. I've seen much of this disease over a lifetime of practice, and I deeply understand its ravages and the debility and (...) suffering it causes. But what you propose is not a good solution for the problems that Alzheimer disease poses for patients, families, and society. It will ultimately do far more harm than good. Please let me try to explain. (shrink)

ABSTRACT ‘Facts remain robust only when … supported by a common culture,’ observes Bruno Latour. Current debates over the veracity of climate change are, in actuality, crises of facts. Questions of facticity have, moreover, precipitated a deeper issue – the prospects of unshared, ‘alternative’ worlds. Climate science believers have one world, climate change deniers another, creating what Latour calls ‘epistemological delirium.’ Following Latour, the paper turns to Pierre Hadot’s description of Stoic physics and understanding of philosophy as spiritual exercise. Finally, (...) taking up both Latour’s claims of ‘alternative worlds’ and Hadot’s notion of spiritual exercise, this paper explores the possibilities of shared practices in light of unshared realities. (shrink)

Pellegrino was there at the beginning of the field. In the 1950s and 60s, before there was a Kennedy Institute of Ethics or a Hastings Center; before the word ‘bioethics’ itself was coined, Pellegrino was writing articles such as "Ethical Considerations in the Practice of Medicine and Nursing," published in 1964. He was among those who started the Society for Health and Human Values—a precursor organization to the American Society for Bioethics and Humanities. He was the founding editor of the (...) Journal of Medicine and Philosophy at a time when the notion that there was a relationship between philosophy and medicine was foreign to both physicians and philosophers. The authors of the articles published in the very .. (shrink)

New Natural Law Theory and the Catholic medico-moral tradition often lead to similar conclusions in hard cases regarding end-of-life care. Considering the provision of artificial nutrition and hydration to patients suffering from post-coma unresponsive wakefulness, however, brings to light subtle ways in which NNL differs from the centuries-old natural law tradition. In this essay, I formalize the methodology embedded within the casuistry of the medico-moral tradition and show how it differs from NNL with respect to the role played by double-effect (...) reasoning and the perspective for analyzing cases regarding care for those who cannot speak for themselves. Importantly, the ordinary/extraordinary means distinction has never historically been understood as an application of double effect and logically cannot be so understood. Given the outsized role that double effect plays in NNL, the theory leads to conclusions that deviate from the Catholic medico-moral tradition and creates additional burdens and duties for the sick. (shrink)

My article, “Whole-brain death and integration: Realigning the ontological concept with clinical diagnostic tests”.

Prestigious University is a large, private educational institution with a medical school, a university hospital, a law school, and graduate and undergraduate colleges all on a single campus. In the face of the Covid‐19 pandemic, students were told during spring break to return to campus only briefly to retrieve their belongings. Classes then went online. On March 23, 2020, the faculty, students, and staff were emailed the following by the university's director of infection control and public health: We have become (...) aware that a Prestigious University staff member has tested positive for the virus that causes Covid‐19. The individual, who was last on campus on March 16, is now in isolation at their permanent residence and is doing well clinically. The university has already identified those members of our community who may have been in close contact with this individual, and we are working to notify them. Further, this individual's local health department has a protocol for identifying people who have been in direct contact with anyone testing positive for Covid‐19 (such as this Prestigious University staff member) so that they can self‐quarantine and watch for COVID‐19 symptoms for a period of 14 days from their last contact with the infected individual.A professor in the Philosophy Department has asked the ethicists at the medical school whether such contact tracing suffices. “Don't the members of the community deserve to know who this is? Isn't there a mandate to identify this person in order to maximize public health benefits and slow the spread of this deadly virus?”. (shrink)

This article explores the relationship between Karl Rahner’s well-known supralapsarian approach to the doctrine of the incarnation and the theme of social salvation. It examines his distinctive supralapsarian approach to the Incarnation of the Word and the implications that Christological emphasis has for understanding not just individual salvation, but corporate or social salvation, including the whole of creation—human and nonhuman alike. First, we situate Rahner’s supralapsarianism within the broader tradition of this Christological approach. Second, we highlight the cosmic significance of (...) Rahner’s supralapsarian argument for the divine ratio for the Incarnation through the lens of “deep incarnation” theology. Finally, we argue that Rahner’s supralapsarian Christology gestures toward a form of “social salvation” understood in a more cosmic and capacious sense. (shrink)

The playful re-working of the idiomatic expression ‘the apple of my eye’ to the ‘eye/I of my Apple’ provides the answer to the question on technology, emphasising its importance for societies, specifically the South African society, and embodied personhood, and at the same time its determinative contextual character. The answer to the question on technology firstly takes as the vantage point a few personal comments by the author in relation to the question at hand. Secondly, brief remarks on technology and (...) approaches to the question are made before the focus on ethics is explicated and motivated. Lastly, a deep concern is identified and is poignantly described as the probable wicked technologisation of the African soul. (shrink)

The German systematic theologian Friedrich Schleiermacher has shaped Western Christian theological thinking in many ways. One such influential way has been his formulation and exposition of religious experience, and specifically the concept of the ‘feeling of absolute dependence’. From a brief account of his understanding of the ‘feeling of absolute independence’, a few critical remarks are made from the broader context of contemporary hermeneutical discourses, focusing on the constitutive role of affectivity and narrative identity in religious experiences of embodied personhood. (...) It is argued that these two themes in revisiting Schleiermacher’s understanding of the ‘feeling of absolute dependence’ can contribute to a more comprehensive understanding of religious experience. (shrink)

Shortly after the Presidential Commission for the Study of Bioethical Issues was constituted in 2010 and days before the commission members were to join a conference call to discuss possible topics for their deliberation, Craig Venter held a press conference announcing that his lab had created a synthetic chromosome for a species of mycoplasma and had inserted this genetic material into organisms of another species of mycoplasma (the genes of which had been deactivated), transforming the host species into the donor (...) species. While not overtly claiming to have “created life in the test tube,” Venter's publicity seemed cleverly designed to provoke the media into reporting his discovery in just that way. The resulting uproar caused President Obama to give his new bioethics commission the assignment of investigating the ethics of the emerging field of synthetic biology. The commission went right to work. It formed working groups to deliberate about parts of the report, feeding ideas and language to the staff members who would do the actual writing, and then present the working group suggestions to the commission as a whole for public deliberation at open meetings. One of those working groups was charged with coming up with ethical principles that would guide the analysis. Having served as a member of that working group, I report here on the process by which these principles emerged and reflect upon the suitability of that process for the work of public bioethics commissions. (shrink)

Media coverage and statements by various Catholic spokespersons regarding the case of Terri Schiavo has generated enormous and deeply unfortunate confusion regarding Church teaching about the use of life-sustaining treatments. Two weeks ago, for example, I received a letter from the superior of a community of Missionary Sisters of Charity, who operate a hospice here in the United States The Missionary Sisters of Charity are the community founded by Mother Theresa, the 20th Century saint whose primary ministry was to rescue (...) dying Untouch-ables from the streets of Calcutta and bring them into her convent where they were washed, sheltered, fed if they were able to eat, prayed for, and cherished. In other words, the sisters gave these poor souls the gift of a death with dignity. The order Mother Theresa founded has continued this ministry, running hospices in the United States and elsewhere for the homeless, the destitute, those dying of AIDS and poverty and drug addiction, and all those dying alone and otherwise unwanted. (shrink)

The Beatitudes have long functioned as a cornerstone for spiritualities of nonviolence. In that tradition, this essay explores how active nonviolence, rooted in the hope of the third Matthean beatitude—“Blessed are the meek for they will inherit the earth”—can be understood as a response to the interrelated cries of the earth and the oppressed within history. To concretize the demands of a political ecology of nonviolence, the essay then examines how the legacies of Western extractive colonialism have shaped the contours (...) of the contemporary planetary emergency, an emergency that is social, cultural, economic, and ecological in nature. The essay concludes by considering how the practice of meekness, in response to the interrelated cries of the earth and the oppressed, might be lived out within the contemporary historical moment. (shrink)

One major argument against prohibiting euthanasia and physician-assisted suicide (PAS) is that there is no rational basis for distinguishing between killing and allowing to die: if we permit patients to die by forgoing life-sustaining treatments, then we also ought to permit euthanasia and PAS. In this paper, the author argues, contra this claim, that it is in fact coherent to differentiate between killing and allowing to die. To develop this argument, the author provides an analysis of Saint Augustine’s distinction between (...) martyrdom and suicide, highlighting the relevance of intention in the assessment of an agent’s actions. As a general matter of ethics, the intentions of agents, not just the outcomes of their actions, matter enormously for drawing distinctions between what is permissible and what is impermissible. Constructing an Augustinian account of this distinction between killing and allowing to die, the author argues that it is coherent to hold that assisted suicide is wrong, while also accepting that it is permissible to withhold or withdraw life-sustaining treatments. (shrink)

The original position contractarian model of ethical reasoning put forth by John Rawls has been examined as a basis for an environmental ethic on three previous occasions in this journal and in Peter Wenz’s Environmental Justice. In this article, I critically examine each of these treatments, analyzing the proposals offered and identifying their shortcomings. I find a total of seven different proposals in this literature for modifying Rawls’ theory to augment its adequacy or as a ground environmental ethics. The diverse (...) difficulties that arise in attempting to apply Rawls suggest the conclusion that Rawlsian ethics may not be a suitable foundation for an adequate long-term environmental ethics. (shrink)

Epistemology is a branch of philosophy that studies the origin, nature and limits of human knowledge. Contemporary epistemology is a theory of knowledge in terms of reasons, evidence, justification and explanation. This book shows how Anglo-American philosophers captivated by the power of modern science and concomitant advances in logic and mathematics mistook knowledge itself to be reducible to the propositions of science and logic. Ethics, along with metaphysics and religion, were cast off as mere expressions of sentiment at best, or (...) as utter nonsense at worst. Is science the only source of knowledge? Can ethics count as knowledge? Are there kinds of knowledge beyond epistemology? This book develops innovative answers to these and other related questions. (shrink)

Some secrets are fine to keep to ourselves, and others are not. At first glance, Clark’s secret seems to be fine, but it may not be if we look further into it. We all know Clark’s big secret: he is Superman. Secrets always belong to someone. This is one of the things that distinguish secrets from information we simply don’t have. Secrecy is morally neutral and can be used for good or bad ends. One other closely linked concept we must (...) distinguish from secrecy is privacy. Clark Kent is a citizen (sort of), but Superman is purely a public persona. In Superman, vol. 2, #2 (February 1987), Lex Luthor figured out Superman’s secret. Superman has confided his true identity to the Kents and Lana. In Clark’s case, there are several reasons for his secret, but the most compelling one is to protect his loved ones. (shrink)

A culture war has been brewing in Singapore since 2009 when a conservative Christian group conducted a reverse takeover of a feminist civil society organization and was subsequently expelled from the organization in a publicized meeting between the two groups. Since then, the state has mediated the contestation of values between religious conservatives and liberal groups allied around issues of gender and sexuality. The culture war between the two sides has revolved around creative protests that have evaded state prohibitions against (...) public contestations over what is legally considered private beliefs and affairs. They involve innovative hybridizations of American discourses on values and rights mixed with Asian emphases on family traditions and sentiments. The COVID-19 pandemic has, however, laid bare the adaptation of the American culture war into the Singaporean public sphere. This article looks at and analyzes COVID-19 vaccine hesitancy among conservative Christians in Singapore and their incorporation of anti-vaccination views from American Christian nationalism into secular framings, invoking legal rights and responsibilities aligned with the state’s nationalist discourse. I argue that this represents a new phase of contestation by conservatives, refashioning their religious views into secular frames of public good and morality serving the secular nation. By doing so, they implicitly challenge the state’s regulation of religion as private interests and beliefs. This altered religious activism has shifted the terms of secularism and loosened the hegemony of the state in defining these terms. (shrink)